The following is a summary of “Sublingual immunotherapy for allergy to shrimp: the nine-year clinical experience of a Midwest Allergy-Immunology practice,” published in the May 2024 issue of Allergy & Immunology by Theodoropoulou, et al.
Dietary restrictions and fear of adverse reactions significantly impact the nutrition, growth, and lifestyle of individuals with food allergies. Although various disease-modifying treatments are being explored, no published clinical data on immunotherapy for crustacean allergies exists. For a study, researchers sought to assess the efficacy and safety of desensitizing individuals to crustaceans through sublingual immunotherapy (SLIT) for the first time, aiming to validate it as a clinical practice modality.
A retrospective review was conducted on patient charts from a Midwest Allergy-Immunology practice between January 2014 and June 2023. Patients with shrimp allergies treated with SLIT were identified, and their responses to oral challenges were evaluated.
The study identified 66 patients who received SLIT for shrimp allergies, either systemic or localized. Patient demographics and comorbidities were consistent with those of the atopic population. SLIT was initiated with serially diluted mixtures at doses ranging from 64 to 320 ng and gradually escalated to 0.5 mg, administered three times daily. The duration of SLIT treatment varied from 5 to 72 months, averaging 51 months. Eighteen patients subsequently underwent shrimp oral challenges, none of whom experienced systemic reactions or required epinephrine. Tolerance to a target dose of 42 g or more of shrimp was achieved by 11 patients (61%), including seven who initially presented with systemic reactions to crustaceans. About 7 patients (38%) experienced localized reactions such as oral itching, nasal symptoms, localized hives, nausea, vomiting, and abdominal pain when exposed to cumulative doses of 39.2 to 148.2 g of shrimp during the 4-hour challenge period. Five of these patients initially had systemic reactions. Subsequently, five patients with localized symptoms were placed on routine exposure to 12-20 g of shrimp every other day, and two continued SLIT without regular shrimp exposure due to lack of intent to incorporate shrimp into their diet. On repeat challenge 6-9 months later, all five patients with routine exposure tolerated the target dose without any symptoms.
Desensitization to shrimp through SLIT appeared to be a safe and effective approach based on the findings of the study. However, it remained unclear whether the immune modification induced by SLIT is permanent or if sustained tolerance depends on regular exposure. Consequently, following the successful challenge, regular consumption of shrimp three to four times per week was recommended.
Reference: aacijournal.biomedcentral.com/articles/10.1186/s13223-024-00895-7
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